Considering new insurance? This chart can help you decide. Contact your prescription insurance provider, benefits/HR manager, or benefits Web site for plan information. Use this chart to answer questions about your plan as well as other plans you’re considering. Compare your coverage options and make the choice that best meets your treatment needs. Plan Option A Does the plan have a deductible? If so, how much? Name of Plan Does the plan have a co-pay ($) or co-insurance (%)? If so, how much? Does the plan have an out-of-pocket maximum? If so, how much? What is the monthly insurance premium? Is your doctor in the plan’s network? Y or N Y or N Y or N Color the blue circle for the plan that’s best for you Plan Option B Plan Option C NOTES
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Considering new insurance?This chart can help you decide.
Contact your prescription insurance provider,
benefits/HR manager, or benefits Web site for
plan information.
Use this chart to answer questions about your
plan as well as other plans
you’re considering.
Compare your coverage options and make the choice that best meets your treatment needs.
Plan Option A
Does the plan have a deductible? If so, how much?
Name of Plan
Does the plan have a co-pay ($) or co-insurance (%)? If so, how much?
Does the plan have an out-of-pocket maximum? If so, how much?
What is the monthly insurance premium?
Is your doctor in the plan’s network?
Y or N Y or NY or N
Color the blue circle for the plan that’s best for you
Plan Option B Plan Option C
NO
TES
Annual limit This is sometimes referred to as a maximum benefit cap. It is a cap on the benefits your insurance plan will pay in a year. These caps are sometimes placed on particular services such as medications or hospitalizations. After you reach the annual limit, you must pay all health care costs for the rest of the year.
Benefits verification Information that summarizes the expected coverage of the medication by the selected insurance plan.
Co-insurance This refers to the fact that the cost of each prescription filled will be a percentage of the medication’s retail cost before the insurance benefits are applied. For example, you may pay 25% of the retail cost.
Co-pay This is the cost of each prescription, which is a fixed amount required by your insurance. For example, you may pay $50.
Co-pay savings card/coupon Manufacturer-sponsored savings that may reduce the out-of-pocket costs for certain medications.
Deductible Your out-of-pocket cost that must be met before your insurance plan begins to pay for health care services or medications. When the deductible is met, there may still be out-of-pocket costs due to a co-insurance or co-pay.
Explanation of benefits (EOB) A notice that summarizes prescription drug claims and out-of-pocket costs.
Get up to speed on insurance terms.It’s important to understand the prescription coverage of your insurance plan. The common
insurance terms defined below may help as you review your coverage options for the coming year. Each insurance plan may vary, so it’s good to understand the differences.
Formulary A list of medications covered by your prescription drug plan or your insurance plan.
Lifetime limit A cap on the total lifetime benefits you may get from your insurance plan. Once you have reached the lifetime maximum benefit, the plan will no longer pay for services or medications.
Open enrollment The time of year when you need to select your insurance plan for the coming year. You can also enroll in a new insurance plan at other times —for example, when starting a new job.
Out-of-pocket maximum The maximum amount you will pay out of pocket before the selected insurance plan will begin to cover 100% of health care services or medication costs.
Pharmacy benefit Typically covers self-administered oral, injectable, and inhaled drugs.
Premium The amount that you pay for your insurance plan. The premium is typically paid monthly, quarterly, or yearly.
Prior authorization Many insurance plans require a prior authorization, or approval. This means your health care provider must provide additional information to help determine if the health care service or medication will be covered. If a prior authorization is not completed, you may pay more for the health care service or medication, or it may not be covered.
